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Shin JY, Lee NH, Kim MS, Roh SG, Chung YK. Limited eye movement caused by clumping of fibrin glue used in blowout fracture surgery: a care report. Arch Craniofac Surg 2022; 23:228-231. [DOI: 10.7181/acfs.2022.00829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022] Open
Abstract
Fibrin glue is a topical agent widely used for hemostasis, wound healing, and surgical adhesion. Complications of fibrin glue itself are extremely rare because it is absorbed over time, but can occur as a result of inappropriate application. We report a case of a postoperative complication caused by inappropriate application of fibrin glue in blow-out fracture surgery. A 65-year-old male patient presented with periorbital swelling and an open wound on the right infraorbital area. Computed tomography showed a right orbital floor fracture. After reduction of the herniated tissue into the orbit, an implant was inserted and fibrin glue was applied to stabilize the implant. This procedure was performed without difficulty, but the patient complained of persistent diplopia and limited eyeball movement after surgery. An imaging study showed a mass-like lesion, which was not a hematoma, in the orbital cavity. In a second operation, the mass was identified as clotted fibrin glue that had not been applied properly. After removal, the patient’s symptoms were relieved without further complications. Appropriate and careful application of fibrin glue is necessary to avoid unnecessary complications.
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Bhar B, Chouhan D, Pai N, Mandal BB. Harnessing Multifaceted Next-Generation Technologies for Improved Skin Wound Healing. ACS APPLIED BIO MATERIALS 2021; 4:7738-7763. [PMID: 35006758 DOI: 10.1021/acsabm.1c00880] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dysregulation of sequential and synchronized events of skin regeneration often results in the impairment of chronic wounds. Conventional wound dressings fail to trigger the normal healing mechanism owing to the pathophysiological conditions. Tissue engineering approaches that deal with the fabrication of dressings using various biomaterials, growth factors, and stem cells have shown accelerated healing outcomes. However, most of these technologies are associated with difficulties in scalability and cost-effectiveness of the products. In this review, we survey the latest developments in wound healing strategies that have recently emerged through the multidisciplinary approaches of bioengineering, nanotechnology, 3D bioprinting, and similar cutting-edge technologies to overcome the limitations of conventional therapies. We also focus on the potential of wearable technology that supports complete monitoring of the changes occurring in the wound microenvironment. In addition, we review the role of advanced devices that can precisely enable the delivery of nanotherapeutics, oligonucleotides, and external stimuli in a controlled manner. These technological advancements offer the opportunity to actively influence the regeneration process to benefit the treatment regime further. Finally, the clinical relevance, trajectory, and prospects of this field have been discussed in brief that highlights their potential in providing a beneficial wound care solution at an affordable cost.
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Affiliation(s)
- Bibrita Bhar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Dimple Chouhan
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Nakhul Pai
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Biman B Mandal
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India.,Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India.,School of Health Science and Technology, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
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The Impact of Fibrin Sealant Volume on Skin Graft Contraction in a Full-Thickness Skin Graft Model. J Craniofac Surg 2020; 31:2156-2159. [PMID: 33136846 DOI: 10.1097/scs.0000000000006629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fibrin sealant has been used for skin grafting in anatomically difficult facial areas. Although biodegradable, an excess of fibrin sealant may inhibit skin graft healing by inhibiting diffusion at the graft-recipient bed interface. The impact of fibrin sealant volume on graft healing was examined in a rat full-thickness skin graft model. METHODS Seventy-two full-thickness 2.5 × 2.5-cm skin grafts were used on the dorsum of male Sprague-Dawley rats. The grafts were treated with three different volumes of fibrin sealant placed onto the recipient bed: 0.0 mL or normal saline (group 1), 0.1 mL (group 2), and 0.4 mL (group 3). Graft healing and complications were assessed using digital photographs and necropsies on postoperative days 3, 7, and 21. RESULTS Group 3 showed the greatest graft contraction on days 3 and 21, while group 2 showed the least contraction on all 3 postoperative days (P = 0.002, 0.004, and <0.001, respectively). Histopathologic analysis showed inflammatory foreign body reactions in group 3 on days 3 and 7, and less vascular density on day 21 (P = 0.003). Group 1 showed the highest incidence of hematoma (P = 0.004). CONCLUSION An excess volume of fibrin sealant may produce pathologic wound contraction in skin grafting because a skin graft lacks a vascular pedicle and is highly dependent on diffusion from the host environment. Before using fibrin sealant for skin grafting in facial areas where the aesthetic outcome is important, the appropriate volume to use can be determined.
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Jain R, Wairkar S. Recent developments and clinical applications of surgical glues: An overview. Int J Biol Macromol 2019; 137:95-106. [DOI: 10.1016/j.ijbiomac.2019.06.208] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 01/10/2023]
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Grunzweig KA, Ascha M, Kumar AR. Fibrin tissue sealant and minor skin grafts in burn surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:871-883. [DOI: 10.1016/j.bjps.2018.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/28/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022]
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Dejyong K, Kaewamatawong T, Brikshavana P, Durongphongtorn S. Efficacy of bubaline fibrin glue on full-thickness pinch and punch skin grafting in a pig. J Biomater Appl 2017; 31:1215-1224. [PMID: 28181448 DOI: 10.1177/0885328217693126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibrin glue, which is formed from the action of thrombin (a serine protease) on fibrinogen, has been developed for use as an adhesive to increase the success of skin graft surgery. The objective of this study was to evaluate if bubaline fibrin glue would promote skin graft survival in pigs. The grafting was divided into two steps. First, granulation wound preparation was performed in a healthy swine by creating four full-skin depth wounds (3 × 12 cm2) at the dorsal part of the loin area on each side. Second, pinch and punch skin grafting, where eight skin discs (0.6 cm diameter) were regularly placed (0.6 cm distance apart) in the granulation tissue bed of each wound, was performed 5 days later. The bubaline fibrin glue was added prior to application of the 16 skin graft discs in two of the wounds, while no glue was added to the other 16 skin graft discs in the other two wounds. The number of surviving graft pieces and histological examination was evaluated after 3, 7, and 14 days post-operation and compared by pairing between the control and the bubaline fibrin glue groups. The number of grafts that remained at 3 and 7 days post-operation and the number of new microvessels at 3 days post-operation were significantly higher ( p < 0.05) in the bubaline fibrin glue group than in the control group. However, there was no significant difference in the number of fibroblasts, the intensity of scarring and the intensity of inflammation between the two groups, except for the significantly lower intensity of inflammation at 7 days post-operation in the bubaline fibrin glue group. In conclusion, bubaline fibrin glue has the advantage of decreasing the skin graft loss by approximately 31.3-37.5% compared with the control group and also promotes angiogenesis.
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Affiliation(s)
- Krittee Dejyong
- 1 Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Theerayuth Kaewamatawong
- 2 Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Pasakorn Brikshavana
- 1 Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Sumit Durongphongtorn
- 1 Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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Han HH, Jun D, Moon SH, Kang IS, Kim MC. Fixation of split-thickness skin graft using fast-clotting fibrin glue containing undiluted high-concentration thrombin or sutures: a comparison study. SPRINGERPLUS 2016; 5:1902. [PMID: 27867809 PMCID: PMC5093101 DOI: 10.1186/s40064-016-3599-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/25/2016] [Indexed: 02/04/2023]
Abstract
Objective For skin defects caused by full-thickness burns, trauma, or tumor tissue excision, skin grafting is one of the most convenient and useful treatment methods. In this situation, graft fixation is important in skin grafting. This study was performed to compare the effectiveness of skin graft fixation between high-concentration fibrin sealant and sutures. There have been numerous studies using fibrin sealant for graft fixation, but they utilized slow-clotting fibrin sealant containing less than 10 IU/mL thrombin. Method Twenty-five patients underwent split-thickness skin grafting using fast-clotting fibrin sealant containing 400 IU/mL thrombin, while 30 patients underwent grafting using sutures. Rates of hematoma/seroma formation, graft dislocation, graft necrosis, and graft take were investigated postoperatively. The graft surface area was calculated using Image J software (National Institutes of Health, Bethesda, MD, USA). Result After 5 days, rates of hematoma/seroma formation and graft dislocation were 7.84 and 1.29% in group I, and 9.55 and 1.45% in group II, respectively. After 30 days, rates of graft necrosis and graft take were 1.86 and 98.14% in group I, and 4.65 and 95.35% in group II. Undiluted fibrin sealant showed significantly superior results for all rates (p < 0.05) except graft dislocation. Conclusion When high-concentration fast-clotting fibrin sealant was applied to skin grafts without dilution, no difficulty was experienced during surgery. Sealant showed superior results compared with sutures and had an excellent graft take rate. Level of evidence II.
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Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Daiwon Jun
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Sook Kang
- Department of Plastic and Reconstructive Surgery,St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Cheol Kim
- Department of Plastic and Reconstructive Surgery,St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Toriumi DM, Chung VK, Cappelle QM. Surgical Adhesives in Facial Plastic Surgery. Otolaryngol Clin North Am 2016; 49:585-99. [DOI: 10.1016/j.otc.2016.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Balceniuk MD, Wingate NA, Krein H, Curry J, Cognetti D, Heffelfiner R, Luginbuhl A. Effects of a Fibrin Sealant on Skin Graft Tissue Adhesion in a Rodent Model. Otolaryngol Head Neck Surg 2016; 155:76-80. [PMID: 26932970 DOI: 10.1177/0194599816634616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/03/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish a rodent model for skin grafting with fibrin glue and examine the effects of fibrin glue on the adhesive strength of skin grafts without bolsters. STUDY DESIGN Animal cohort. SETTING Academic hospital laboratory. SUBJECTS AND METHODS Three skin grafts were created using a pneumatic microtome on the dorsum of 12 rats. Rats were evenly divided into experimental (n = 6) and control (n = 6) groups. The experimental group received a thin layer of fibrin glue between the graft and wound bed, and the control group was secured with standard bolsters. Adherence strength of the skin graft was tested by measurement of force required to sheer the graft from the recipient wound. Adhesion strength measurements were taken on postoperative days (PODs) 1, 2, and 3. RESULTS The experimental group required an average force of 719 g on POD1, 895 g on POD2, and 676 g on POD3, while the average force in the control group was 161 g on POD1, 257 g on POD2, and 267 g on POD3. On each of the 3 PODs, there was a significant difference in adherence strength between the experimental and control groups (P = .036, P = .029, P = .024). CONCLUSION There is a significant difference in the adhesion strength of skin grafts to the wound bed in the early postoperative period of the 2 groups. In areas of high mobility, using the fibrin sealant can keep the graft immobile during the critical phases of early healing.
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Affiliation(s)
- Mark D Balceniuk
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nicholas A Wingate
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Howard Krein
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ryan Heffelfiner
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Jeschke MG, Finnerty CC, Shahrokhi S, Branski LK, Dibildox M. Wound coverage technologies in burn care: novel techniques. J Burn Care Res 2013; 34:612-20. [PMID: 23877140 PMCID: PMC3819403 DOI: 10.1097/bcr.0b013e31829b0075] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Improvements in burn wound care have vastly decreased morbidity and mortality in severely burned patients. Development of new therapeutic approaches to increase wound repair has the potential to reduce infection, graft rejection, and hypertrophic scarring. The incorporation of tissue-engineering techniques, along with the use of exogenous proteins, genes, or stem cells to enhance wound healing, heralds new treatment regimens based on the modification of already existing biological activity. Refinements to surgical techniques have enabled the creation of protocols for full facial transplantation. With new technologies and advances such as these, care of the severely burned will undergo massive changes over the next decade. This review centers on new developments that have recently shown great promise in the investigational arena.
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Affiliation(s)
- Marc G. Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery and Plastic Surgery, University of Toronto, Toronto, Canada
| | - Celeste C. Finnerty
- Department of Surgery, Sealy Center for Molecular Medicine, and the Institute for Translational Science, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas, USA
| | - Shahriar Shahrokhi
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery and Plastic Surgery, University of Toronto, Toronto, Canada
| | - Ludwik K. Branski
- Department of Plastic and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Manuel Dibildox
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery and Plastic Surgery, University of Toronto, Toronto, Canada
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Hermeto LC, Rossi RD, Pádua SBD, Pontes ERJ, Santana AE. Comparative study between fibrin glue and platelet rich plasma in dogs skin grafts. Acta Cir Bras 2013; 27:789-94. [PMID: 23117611 DOI: 10.1590/s0102-86502012001100008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Compare fibrin glue (Tissucol(®)) and platelet-rich plasma in full-thickness mesh skin grafts in dogs. METHODS Eighteen dogs were used, divided into two groups: fibrin glue (FG) and platelet-rich plasma (PRP). In all the animals, a full-thickness 3x3 cm mesh skin graft was implanted. In the left limb, the biomaterial was place between the graft and the receptor bed, according to the group, while the right limb served as the control group. All the animals were evaluated clinically every 48 hours until the 14th day, using the variables of exudation, coloration, edema and cosmetic appearance. Three animals were evaluated histologically, on the third, seventh and tenth postoperative days, using the variables of fibroblasts, collagen, granulation tissue, microscopic integration-adherence and acute inflammation. RESULTS Clinical evaluations showed that the group CF showed better scores for all variables compared to PRP group. On the histological evaluations PRP group had a higher presence of fibroblasts in the seventh and fourteenth days. CONCLUSION The fibrin glue group was clinically superior to the platelet-rich group when used on full-thickness skin grafts in dogs.
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Affiliation(s)
- Larissa Correa Hermeto
- Postgraduate Program in Veterinary Surgery, School of Agrarian and Veterinary Sciences, UNESP, Jaboticabal-SP, Brazil.
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An Open, Prospective, Randomized Pilot Investigation Evaluating Pain With the Use of a Soft Silicone Wound Contact Layer Vs Bridal Veil and Staples on Split Thickness Skin Grafts as a Primary Dressing. J Burn Care Res 2013; 34:674-81. [DOI: 10.1097/bcr.0b013e3182853cd6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Vetter TS, Mowlds DS, Scholz T, Nam SB, Lin F, Owens JW, Dey D, Wirth GA, Evans GRD. Enhanced cryoprecipitate for skin graft and donor site wound healing in pigs. Int Wound J 2012; 11:169-76. [PMID: 22905755 DOI: 10.1111/j.1742-481x.2012.01059.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Due to similarities in skin characteristics, the authors hypothesise that a pig model would most accurately show the ability of autologous, enhanced cryoprecipitate (eCryo) to improve the wound healing of split-thickness skin grafts (STSGs) and corresponding donor sites. Fifty-two STSGs (5 × 5 cm) were fashioned and treated according to a randomised protocol with an autologous eCryo-treated and a control group. Macroscopic assessment, histological evaluation and cellular composition were completed at days 7, 14, 21 and 28. Thirty-two donor sites were also created and assessed in a similar manner. Histologic analysis showed enhancement of healing over all time points for eCryo-treated donor sites. All other results showed no statistically significant improvement with the use of eCryo. Autologous cryoprecipitate appears to be a safe, inexpensive and easy-to-use alternative to fibrin glue, which carries risks and is, in many cases, prohibitively expensive. Further studies are necessary to evaluate the full potential of eCryo. Interestingly, eCryo application may improve donor site aesthetic appearance. We believe that a pig model most reliably simulates eCryo's behaviour in humans to accurately reflect its future clinical applicability.
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Affiliation(s)
- Thomas Sebastian Vetter
- Aesthetic & Plastic Surgery Institute, University of California, Irvine, CA, USADepartment of Plastic & Reconstructive Surgery, Pusan National University Hospital, Busan, KoreaDepartment of Pathology, University of California, Irvine, CA, USADepartment of Medicine, University of California, Irvine, CA, USA
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Chaurasia SS, Champakalakshmi R, Angunawela RI, Tan DT, Mehta JS. Optimization of Fibrin Glue Spray Systems for Ophthalmic Surgery. Transl Vis Sci Technol 2012; 1:2. [PMID: 24049702 DOI: 10.1167/tvst.1.2.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/13/2012] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To optimize fibrin glue (FG) spray for ophthalmic surgery using two spray applicators, EasySpray and DuploSpray systems, by varying the distance from point of application and the pressure/flow rate, and to compare the adhesive strength of sutured and sutureless (FG sprayed) conjunctival graft surgery in a rabbit model. METHODS FG was sprayed on a 0.2 mm-thick sheet of paper using EasySpray by variously combining application distances of 2.5, 5, 7.5, and 10 cm with pressures of 10, 15, and 20 psi. DuploSpray was used at the same distances but with varying flow rates of 1 and 2 L/min. Subsequently, FG was sprayed on porcine corneas and FG thickness was analyzed by histology. In addition, adhesive strength of the conjunctival graft (0.5 × 0.5 cm) attached to the rabbit cornea by sutured and sutureless surgery (FG spray) was compared using a tension meter. RESULTS Histology measurements revealed that the FG thickness decreased with increases in distance and pressure of spray using the EasySpray applicator on paper and porcine corneal sections. The adhesive strength of the sutured conjunctival graft (41 ± 4.85 [kilopascal] KPa) was found to be higher than the graft attached by spraying (10 ± 2.3 KPa) and the sequential addition of FG (6 ± 0.714 KPa). CONCLUSIONS The EasySpray applicator formed a uniform spread of FG at a distance-pressure combination of 5 cm and 20 psi. The conjunctival graft attached with sutures had higher adhesive strength compared with grafts glued with a spray applicator. Although the adhesive strength of FG applied through the applicator was similar to the drop-wise sequential technique, the former was more cost effective because more samples could be sprayed compared with the sequential manual technique. TRANSLATIONAL RELEVANCE The standardization of the spray system for the application of FG in ophthalmology will provide an economical method for delivering consistent healing results after surgery.
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Affiliation(s)
- Shyam S Chaurasia
- Tissue Engineering and Stem Cell Research Group, Singapore Eye Research Institute (SERI), Singapore
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Spotnitz WD. Efficacy and safety of fibrin sealant for tissue adherence in facial rhytidectomy. Clin Cosmet Investig Dermatol 2012; 5:43-51. [PMID: 22791995 PMCID: PMC3391924 DOI: 10.2147/ccid.s25747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of this review is to clarify the present use of fibrin sealant in rhyditectomy procedures and help maximize the appropriate and safe application of this material. A set of terms and definitions for hemostats, sealants, and adhesives based on group, category, and class will be employed to highlight the specific capabilities of fibrin sealant. Fibrin sealant has now emerged as an example of maximizing the usefulness of a surgical agent and is the only product with Food and Drug Administration approval in all three groupings: hemostats; sealants; and adhesives. A variety of manufacturers’ fibrin sealant products are available including multiple liquids and one patch. A single liquid product is now specifically indicated for skin flap adherence during rhytidectomy. The unique characteristic of this particular two component fibrin sealant adhesive agent is its slower polymerization rate as a result of a low thrombin concentration which when combined with fibrinogen permits adequate time for manipulation of flaps and tissues prior to final fixation. In addition to its flap adherence and potential space elimination capability, fibrin sealant is also an excellent blood clotting agent and can seal tissues to prevent lymphatic leak or serous fluid accumulation. Thus, it is almost ideally suited to reduce the occurrence of fluid accumulation, hematomas, ecchymoses, and swelling, as well as to possibly eliminate the need for drains following rhytidectomy. A literature review of fibrin sealant in rhytidectomy is included to help define the current state of its clinical use. The author’s recommendations for the best use of this material during facial procedures are also provided.
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Affiliation(s)
- William D Spotnitz
- The Surgical Therapeutic Advancement Center, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
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Branski LK, Mittermayr R, Herndon DN, Jeschke MG, Hofmann M, Masters OE, Norbury WB, Traber DL, Tangl S, Redl H. Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model. Burns 2011; 37:1360-6. [DOI: 10.1016/j.burns.2009.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 08/06/2009] [Accepted: 08/09/2009] [Indexed: 10/18/2022]
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Marques M, Brown SA, Cordeiro NDS, Rodrigues-Pereira P, Cobrado ML, Morales-Helguera A, Queirós L, Luís A, Freitas R, Gonçalves-Rodrigues A, Amarante J. Effects of coagulase-negative staphylococci and fibrin on breast capsule formation in a rabbit model. Aesthet Surg J 2011; 31:420-8. [PMID: 21551433 DOI: 10.1177/1090820x11404400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The etiology and ideal clinical treatment of capsular contracture (CC) remain unresolved. Bacteria, especially coagulase-negative staphylococci, have been previously shown to accelerate the onset of CC. The role of fibrin in capsule formation has also been controversial. OBJECTIVE The authors investigate whether fibrin and coagulase-negative staphylococci (CoNS) modulate the histological, microbiological, and clinical outcomes of breast implant capsule formation in a rabbit model and evaluate contamination during the surgical procedure. METHODS Thirty-one New Zealand white female rabbits were each implanted with one tissue expander and two breast implants. The rabbits received (1) untreated implants and expanders (control; n = 10), (2) two implants sprayed with 2 mL of fibrin and one expander sprayed with 0.5 mL of fibrin (fibrin; n = 11), or (3) two implants inoculated with 100 µL of a CoNS suspension (10(8)CFU/mL-0.5 density on the McFarland scale) and one expander inoculated with a CoNS suspension of 2.5 × 10(7) CFU/mL (CoNS; n = 10). Pressure/volume curves and histological and microbiological evaluations were performed. Operating room air samples and contact skin samples were collected for microbiological evaluation. The rabbits were euthanized at four weeks. RESULTS In the fibrin group, significantly decreased intracapsular pressures, thinner capsules, loose/dense (<25%) connective tissue, and negative/mild angiogenesis were observed. In the CoNS group, increased capsular thicknesses and polymorph-type inflammatory cells were the most common findings. Similar bacteria in capsules, implants, and skin were cultured from all the study groups. One Baker grade IV contracture was observed in an implant infected with Micrococcus spp. CONCLUSIONS Fibrin was associated with reduced capsule formation in this preclinical animal model, which makes fibrin an attractive potential therapeutic agent in women undergoing breast augmentation procedures. Clinical strategies for preventing bacterial contamination during surgery are crucial, as low pathogenic agents may promote CC.
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Affiliation(s)
- Marisa Marques
- Hospital de Sao Joao, Servico de Cirurgia Plastica, Porto, Portugal.
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The Use of Fibrin Tissue Glue in the Repair of Cicatricial Ectropion of the Lower Eyelid. Ophthalmic Plast Reconstr Surg 2010; 26:409-12. [DOI: 10.1097/iop.0b013e3181cc856b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Henderson NJ, Fancourt M, Gilkison W, Kyle S, Mosquera D. Skin grafts: a rural general surgical perspective. ANZ J Surg 2009; 79:362-6. [DOI: 10.1111/j.1445-2197.2009.04890.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scholz T, Waltzman J, Wirth GA, Dyson SW, Owens WJ, Shanbrom E, Evans GRD. Novel cryoprecipitate for wound healing and skin grafts in rats. Int Wound J 2009; 5:490-501. [PMID: 19031493 DOI: 10.1111/j.1742-481x.2008.00520.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The authors sought to evaluate the ability of locally administered enhanced cryoprecipitate (eCryo) to improve the wound healing of split thickness skin grafts (STSG) and their donor sites. An STSG (5 x 5 cm) was harvested on the back of 30 rats and divided into four areas that were then treated in one of the following groups: A: 'standard' dressing without STSG; B: eCryo without STSG; C: eCryo with STSG coverage and D: STSG alone. Macroscopic and histological assessments (histomorphometric grading scale and cellular composition) were evaluated at days 7, 14, 21 and 28 for wound healing. All wound beds as well as STSGs healed well without any complications. Eighty per cent of the STSG showed a histological graft take of >75% after 28 days. There were no statistically significant differences of macroscopic or histological results between the groups at any time point. Preparation of eCryo is easy and effective. Its use as an adhesive for STSGs is safe and shows similar results as controls. The theoretical benefits of eCryo did not show significant differences. Possible reasons as well as important findings for future research on wound healing are discussed.
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Affiliation(s)
- Thomas Scholz
- Aesthetic & Plastic Surgery Institute, University of California, Irvine, Orange, CA 92868-3298, USA
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Improvement of Full-Thickness Skin Graft Survival by Application of Vascular Endothelial Growth Factor in Rats. Ann Plast Surg 2008; 60:589-93. [DOI: 10.1097/sap.0b013e31816d78fe] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gibran N, Luterman A, Herndon D, Lozano D, Greenhalgh DG, Grubbs L, Schofield N, Hantak E, Callahan JD, Schiestl N, Riina LH. Comparison of fibrin sealant and staples for attaching split-thickness autologous sheet grafts in patients with deep partial- or full-thickness burn wounds: a phase 1/2 clinical study. J Burn Care Res 2007; 28:401-8. [PMID: 17438504 DOI: 10.1097/bcr.0b013e318053d389] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We undertook a multicenter, randomized, controlled, phase 1/2 clinical study to investigate the safety and efficacy of a fibrin sealant containing 4 IU/ml thrombin (FS 4IU) for the attachment of autologous sheet grafts in patients with deep partial-thickness or full-thickness burn wounds. Fibrin sealant (FS 4IU) was compared with staples for adherence of sheet grafts in 40 patients. Patients had to have burn wounds measuring 40% TBSA or less with two comparable test sites measuring between 1% and 4% TBSA each. Wound beds were prepared before treatment assignment, which was randomized. Percent area of hematoma/seroma at Day 1 (P = .0138) and questionable viability at Day 5 (P = .0182) were significantly less for FS 4IU-treated sites. Median percent area of graft survival on Day 14 was 100% for both treatments (P = .3525). The percentage of completely closed sites generally was greater for FS 4IU-sites on Days 5 to 91; the maximum difference occurred at Day 28 (79.5% vs 59%; P = .0215). The safety profile of FS 4IU was excellent as indicated by the lack of any related serious adverse experiences. These findings indicate that FS 4IU is safe and effective for fixation of skin grafts, with outcomes similar to or better than staple fixation. The data suggest that FS 4IU is a promising candidate for further clinical studies focusing on skin graft adhesion and burn wound healing.
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Affiliation(s)
- Nicole Gibran
- University of Washington Burn Center, Seattle, Washington, USA
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Mittermayr R, Wassermann E, Thurnher M, Simunek M, Redl H. Skin graft fixation by slow clotting fibrin sealant applied as a thin layer. Burns 2006; 32:305-11. [PMID: 16522355 DOI: 10.1016/j.burns.2005.10.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 10/06/2005] [Indexed: 10/24/2022]
Abstract
Human fibrin sealant (FS) has been proven effective for skin grafting after severe burn, however no systematic evaluation of application conditions has been performed so far. In order to find the optimal FS amount for fixation of skin grafts to deep defects, we created four full thickness wounds (8 cmx4 cm) on the dorsum of six male pigs. Wounds were covered with unmeshed split thickness skin grafts and fixed either with a thin layer (0.05 ml/cm2) or a thick layer (0.15 ml/cm2) of fibrin sealant (FS) without additional sutures. Sutures served as controls. FS was used as a slow clotting spray (4-5 IUthrombin/ml). Outcome measurements revealed that hematoma formation (day of surgery) was more extensive and occurred more frequently in the suture group as compared to FS 0.05 ml/cm2 (p<0.05). Areas of graft dislocation tended to be larger in the suture group versus the FS 0.05 ml/cm2. The FS 0.05 ml/cm2 graft take on day 5 appeared to be enhanced in comparison to the suture group. Excellent outcome was notable on the final observation day (day 21) in the FS 0.05 ml/cm2 group with a take of 99.7% (IQR 96.1-100%). Corresponding values in the FS 0.15 ml/cm2 group were 96.9% (IQR 92.2-99%) and 95.9% (IQR 93.2-98%) in the suture group. The results indicate, that the usage of a sprayed thin FS layer (0.05 ml/cm2) in a slow clotting rate (4-5 IUthrombin/ml) is an appropriate fixation method in split thickness skin transplantation.
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Affiliation(s)
- Rainer Mittermayr
- Research Center of the AUVA, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria.
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Albala DM, Lawson JH. Recent clinical and investigational applications of fibrin sealant in selected surgical specialties. J Am Coll Surg 2006; 202:685-97. [PMID: 16571441 DOI: 10.1016/j.jamcollsurg.2005.11.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 11/21/2005] [Accepted: 11/30/2006] [Indexed: 01/06/2023]
Affiliation(s)
- David M Albala
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Atalay C, Kockaya EA, Cetin B, Akay MT. The role of fibrin tissue adhesives in flap necrosis in rats. J INVEST SURG 2005; 18:97-100. [PMID: 16036778 DOI: 10.1080/08941930590929804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Flap necrosis is an important issue in surgery, and fibrin tissue adhesives, due to beneficial properties in preventing flap necrosis, were used in this study. Two groups, each comprising of 10 rats, were formed. Group I served as a control group, and fibrin tissue adhesive was applied to group II. The fibrinogen and thrombin concentrations in fibrin tissue adhesive were 30 mg/ml and 10 U/ml, respectively. The mean area of flap necrosis was 687.5 +/- 72.5 mm2 and 78.5 +/- 11.0 mm2 in the control and fibrin tissue adhesive groups (p < .0001), respectively. The percentage of flap necrosis was significantly lower in the fibrin tissue adhesive group compared to the control group (5.6% vs 49.1%) (p < .0001). Fibrin tissue adhesives decreased flap necrosis significantly compared to the control group.
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Affiliation(s)
- Can Atalay
- Department of General Surgery, Ankara Oncology Hospital, Ankara, Turkey.
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Abstract
Optimal treatment of burn victims requires deep understanding of the profound pathophysiological changes occurring locally and systemically after injury. Accurate estimation of burn size and depth, as well as early resuscitation, is essential. Good burn care includes also cleansing, debridement, and prevention of sepsis. Wound healing, is of major importance to the survival and clinical outcome of burn patients. An ideal therapy would not only promote rapid healing but would also act as an antiscarring therapy. The present article is a literature review of the most up-to-date modalities applied to burn treatment without overlooking the numerous controversies that still persist.
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Affiliation(s)
- Bishara S Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center on Burns and Fire Disasters, Beirut, Lebanon.
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Affiliation(s)
- Steven Ross Mobley
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Illinois at Chicago, 1855 West Taylor, Chicago, IL 60612, USA
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Partsafas AW, Bascom DA, Jorgensen SA, Wax MK. Effects of Tisseel and FloSeal on Primary Ischemic Time in a Rat Fasciocutaneous Free Flap Model. Laryngoscope 2004; 114:301-4. [PMID: 14755208 DOI: 10.1097/00005537-200402000-00023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Free flaps are the technique of choice for reconstruction of defects resulting from extirpation of tumors of the head and neck. Advances in microsurgical technique have resulted in success rates of greater than 95%. Numerous intraoperative factors, ranging from technical issues to topically applied agents, can complicate the outcome of microsurgical free tissue transfer. Synthetic tissue adhesives and hemostatic agents are playing an ever-increasing role in reconstructive surgery. The safety of these factors in free flap surgery has not been ascertained. STUDY DESIGN Animal Care Committee live rat model. METHODS Male Sprague-Dawley rats were divided into three groups: group I, Control; group 2, FloSeal; group 3, Tisseel. In each group, a 3 x 6 cm ventral fasciocutaneous groin flap based on the left superficial epigastric artery was elevated and the experimental material applied beneath the flap and around the flap pedicle prior to suturing of the flap back to the wound bed. The experimental materials consisted of 0.2 mL saline in the control group, 0.5 mL FloSeal, and 0.2 mL Tisseel. In phase I of this study, the effect of each treatment on flap survival was assessed by survival at postoperative day 4. In phase II of the study, the effects of these agents on ischemic tolerance was investigated. Five rats in each treatment group were exposed to ischemic times of 6, 8, 10, and 12 hours. Survival of the flap was assessed 7 days after reversal of the ischemia. Probit curves and the critical ischemic time (CIT50) were calculated. RESULTS All flaps survived the 2-hour period of ischemia and were viable at postoperative day 4. Flap survival from group 1 (Control), group 2 (FloSeal), and group 3 (Tisseel) at the various ischemic times was as follows: at 6 hours, 80%, 80%, and 80%, respectively; at 8 hours, 80%, 80%, 60%; at 10 hours, 60%, 33%, 40%; at 12 hours, 20%, 20%, 0%. The CIT50 for the Control, FloSeal, and Tisseel groups was 9.4, 9.0, and 7.0 hours, respectively.CONCLUSIONS FloSeal, a thrombin-based hemostatic agent, and Tisseel, a fibrin glue, displayed no adverse effect on flap survival in this model.
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Brissett AE, Hom DB. The effects of tissue sealants, platelet gels, and growth factors on wound healing. Curr Opin Otolaryngol Head Neck Surg 2003; 11:245-50. [PMID: 14515071 DOI: 10.1097/00020840-200308000-00005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The improved understanding of wound healing has resulted in the rapid expansion of tissue adhesives, platelet gels, and the use of growth factors. Tissue sealants have been used to close incisions, seal and secure skin flaps, as well as promote hemostasis. Platelet gels have multiple uses that take advantage of their inherent clot-forming ability as well as their potential to release growth factors. Recombinant platelet-derived growth factor has been studied extensively for the treatment of chronic dermal ulcers and shows promise in enhancing wound care. This article will address some recent advancements related to the expanding use of tissue sealants and growth factors to enhance wound healing within the head and neck area.
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Affiliation(s)
- Anthony E Brissett
- Bobby R. Alford Department of Otolaryngology/Head and Neck Surgery and Communicative Sciences, Baylor College of Medicine, Houston, Texas, USA
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